Does Metastasectomy Improve Survival in Patients With Stage IV Melanoma? A Cancer Registry Analysis of Outcomes

Introduction: Patients with Stage IV melanoma have limited therapeutic options with few long-term survivors. Our goal was to study the impact of metastasectomy on survival in these patients. Methods: Patients with Stage IV melanoma were identified from the Surveillance, Epidemiology, and End Results (SEER) database (1988-2006). Those who had metastasectomy performed were compared with patients that did not. Results: The median age of the study population (n = 4,229) was 63 years and median survival was 7 months. Patients who underwent metastasectomy (33.6%) had an improved median and 5-year overall survival as compared to patients who did not; 12 months versus 5 months and 16% versus 7% (P < 0.001). In patients with M1a disease (n = 1,994), this improvement of survival following metastasectomy was enhanced; median survival of 14 months versus 6 months and 5-year overall survival of 20% versus 9% (P < 0.001). Younger age and diagnosis from 2001 to 2006 were predictors of metastasectomy. Metastasectomy was an independent and significant predictor of survival for the entire cohort (HR 0.59, 95% CI 0.55-0.63). Conclusions: Metastasectomy in patients with Stage IV melanoma may improve long-term survival. The true therapeutic benefit, if any, of metastatectomy needs to be determined by a randomized trial. J. Surg. Oncol. 2011;104:111-115. (C) 2011 Wiley-Liss, Inc.